MedStar Health plan for Bel Air facility worth scrutinizing

Editorial from The Aegis

Even as the future of health care and how it will be provided and paid for remain a subject of much discussion at many levels thanks to the enactment of the federal health care reform law that has come to be called ObamaCare by critics and supporters alike, private health care businesses have been pressing ahead with some rather large scale plans.

It's hard to drive into east Baltimore without noticing the massive overhaul that is coming to fruition at the already gigantic Johns Hopkins Hospital. A few blocks away, Mercy Hospital in the city has a slick new look, that was heralded in equally slick TV ads about a year or so ago using a version of Marvin Gaye's "Mercy Me" as a theme song.

In Havre de Grace, Upper Chesapeake Health is well into the tedious planning process for opening a new hospital near the I-95 interchange with Route 155 to replace the aging Harford Memorial Hospital in the heart of the old part of the city. In Bel Air, the grass has hardly started to grow where construction equipment had been parked during the latest expansion of Upper Chesapeake Medical Center.

And this week comes word that MedStar, parent company of Franklin Square Hospital in Essex, is planning a 100,000-square-foot medical center at the southern end of Bel Air near the intersection of Plumtree Road and Route 924 (already a development debate hot spot because of a Walmart planned for the same corner).

It would appear the demand is strong for medical services, and such demand doesn't necessarily come as much of a surprise. Two decades ago, local government planners across the country were talking about the large degree to which the elderly were going to dominate the population not only in Maryland, but also across the country. A key concern then was that the older you are, the greater your health care needs.

To a degree, therefore, the expansion and modernization of hospitals and related health care facilities across the region is something that is driven, at least in part, by demand.

How much it is driven by demand, and what other forces may be at play, however, are issues that need to be carefully considered.

Hospital health care though it is one of the Baltimore area's leading industries and local institutions are world leaders in many fields is not a business. MedStar, Hopkins, Mercy and Upper Chesapeake Health System are all not-for-profit corporations. They're multi-million-dollar operations, but they aren't driven by profit motive, strictly speaking. This is a double-edged sword. There is no incentive for hospitals to keep stockholders happy by cutting costs, but there also is no incentive to be frugal when frugality is what is called for.

Moreover, the reasons behind why health care institutions take certain paths can sometimes be influenced by the paths taken by other health care institutions. A case in point is the hard lesson learned nearly two decades ago by Upper Chesapeake Health. In the 1980s, advances in hospital technology had made certain procedures that once required long hospital stays things that could be done in a hospital clinic without so much as an overnight stay. Even so, hospitals were still keeping patients overnight or longer for such procedures because they'd always done it that way.

Then it became something of an industry mantra to change that and reduce costs by reducing the length of hospital stays for certain low-risk, routine procedures. So far, so good.

Then cost-cutting seemed to become something of an end unto itself for some hospital organizations, and it appeared Upper Chesapeake had fallen into the trap of going too far down the path of cutting costs, and quality of care suffered even as the not-for-profit company banked large cash reserves. It took massive changes to turn all that around, but it was turned around.

The point in all this as it applies to the planned MedStar project is that there is probably increasing reason to begin to question whether expansion plans proffered by not-for-profit hospital companies are the result of responding to a true need or demand, or if they are just the efforts by that company to follow the national trend, be that trend one of cutting costs or spending on new buildings.

It is very much the responsibility of local elected officials, as agents of the voters, to begin asking these questions because not-for-profit hospital companies provide a vital and important service to the community and it is imperative that the service be maintained at a high level.

Though they are private companies, there is a substantial public policy interest in making sure their decisions serve the general public, and it falls to state and local governments to act as a check in this regard.